1
|
Mitguard S, Doucette O, Miklavcic J. Human milk polyunsaturated fatty acids are related to neurodevelopmental, anthropometric, and allergic outcomes in early life: a systematic review. J Dev Orig Health Dis 2023; 14:763-772. [PMID: 38254254 DOI: 10.1017/s2040174423000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Polyunsaturated fatty acids are critically important for newborn nutrition and in the trajectory of growth and developmental processes throughout early life. This systematic review (PROSPERO ID: CRD42023400059) critically analyzes literature pertaining to how omega-3 and omega-6 fatty acids in human milk are related to health outcomes in early life. Literature selected for the review were published between 2005 and 2020 and included assessments in healthy term children between 0 and 5 years of age. The studies reported the relation between human milk fatty acids docosahexaenoic acid (C22:6n-3, DHA), eicosapentaenoic acid (C20:5n-3, EPA), alpha-linolenic acid (C18:3n-3, ALA), arachidonic acid (C20:4n-6, AA), and linoleic acid (C18:2n-6, LA) with three domains of health outcomes: neurodevelopment, body composition, and allergy, skin & eczema. Results from the 21 studies consistently suggested better health outcomes across the three domains for infants consuming milk with higher concentrations of total n-3, DHA, EPA, and ALA. Negative health outcomes across the three domains were associated with higher levels of total n-6, AA, and LA in milk. N-3 and n-6 content of milk were related to neurodevelopmental, body composition, and allergy, skin & eczema outcomes with moderate certainty. Maternal diet impacting milk fatty acid content and fatty acid desaturase genotype modifying physiologic responses to fatty acid intake were prominent gaps identified in the review using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and GRADE approach. This research study can inform baby nutrition product development, and fatty acid intake recommendations or dietary interventions for mothers and children.
Collapse
Affiliation(s)
- Saori Mitguard
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Olivia Doucette
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - John Miklavcic
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
- School of Pharmacy, Chapman University, Irvine, CA, USA
| |
Collapse
|
2
|
Dobrow L, Estrada I, Burkholder-Cooley N, Miklavcic J. Potential Effectiveness of Registered Dietitian Nutritionists in Healthy Behavior Interventions for Managing Type 2 Diabetes in Older Adults: A Systematic Review. Front Nutr 2022; 8:737410. [PMID: 35141261 PMCID: PMC8819057 DOI: 10.3389/fnut.2021.737410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose A systematic review was conducted to assess how the involvement of a registered dietitian nutritionist (RDN) in healthy behavior interventions (HBIs) potentially affects outcomes in older adults with type 2 diabetes (T2D). Methods Literature was searched for primary research published between 2016 and 2020 on HBI involving a RDN affecting outcomes in older adults with T2D. Evaluations of hemoglobin A1c (HbA1c), blood glucose, blood pressure, cholesterol, anthropometry, body composition, medication usage, healthcare cost, and self-efficacy and/or adherence to healthy behaviors outcomes were selected for inclusion. All the literature included were summarized, evaluated for certainty of evidence criteria, and assessed for bias. Results A total of 12 studies were included for assessment. Involvement of a RDN in HBI was shown to reduce HbA1c, fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure and improve lean body mass, body mass index (BMI), and self-efficacy in populations of older adults with T2D. Compared to older adults with T2D receiving HBI involving RDNs, patients receiving usual care may incur higher healthcare costs or longer hospital stays. There was a high certainty of evidence for a RDN involvement in HBI with regard to reduction in HbA1c. There was a moderate certainty of evidence for a RDN involvement in HBI with regard to favorable changes in weight or body composition and cardiometabolic health outcomes. Statistically significant improvements in outcomes were usually sustained in follow-up after conclusion of HBI. Conclusion RDNs may play an integral role in HBIs resulting in improved glycemic control, weight management, cardiovascular outcomes, and presumably comorbidity management. RDNs are important facilitators of diet education and nutrition assessment, which are essential in T2D management and should, therefore, be considered for routine inclusion in interprofessional teams for improved outcomes in older adults with T2D.
Collapse
Affiliation(s)
- Laurel Dobrow
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Isabella Estrada
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | | | - John Miklavcic
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
- School of Pharmacy, Chapman University, Irvine, CA, United States
- *Correspondence: John Miklavcic
| |
Collapse
|
3
|
Miklavcic J, Bickmore D, Glynn L. The Polyunsaturated Fatty Acid Profile of Extracellular Vesicles in Human Milk. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa054_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Mammalian cells produce extracellular vesicles that function in intercellular communication. There is very little known about the structure of extracellular vesicles that are present in human milk. This research aimed to characterize the fatty acid composition of extracellular vesicles in human milk relative to the whole milk.
Methods
Mothers (n = 35) provided milk two weeks postpartum and the samples were frozen. Samples were thawed and de-fatted before extracellular vesicles were isolated using a precipitation reagent. The whole milk and corresponding samples of extracellular vesicles were analyzed for total fatty acid composition by liquid chromatography-coupled mass spectrometry.
Results
Docosahexaenoic (22:6n-3) acid (r,2 = 0.54; P < 0.001) and eicosapentaenoic (20:5n-3) acid (r,2 = 0.62; P < 0.001) content in extracellular vesicles from milk and in the whole milk were highly correlated. Other individual fatty acids (16:0, 18:0, 18:1, 18:2n-6, 18:3n-3, 20:4n-6) and total saturated, unsaturated, and polyunsaturated fatty acids were not significantly correlated in extracellular vesicles from milk and in the whole milk. The content of docosahexaenoic acid and eicosapentaenoic acid were enriched 1.5-fold in the whole milk relative to extracellular vesicles from milk. Linoleic (18:2n-6) acid and alpha-linolenic (18:3n-3) acid were enriched 3- and 2-fold respectively in extracellular vesicles from milk relative to the whole milk.
Conclusions
Extracellular vesicles in milk are enriched in essential fatty acid precursors (18:2n-6, 18:3n-3) and the whole milk is enriched in long-chain omega-3 products (22:6n-3, 20:5n-3). Polyunsaturated fatty acids are partitioned in human milk extracellular vesicles in a discriminate manner.
Funding Sources
The research was supported by the NIH and University institutional funds.
Collapse
|
4
|
|
5
|
Fraser K, Punjani NS, Wilkey B, Labonte S, Lartey S, Gubersky J, Nickoriuk K, Joseph S, Younus S, Miklavcic J. Optimizing Licensed Practical Nurses in Home Care: Their Role, Scope and Opportunities. ACTA ACUST UNITED AC 2019; 32:42-59. [PMID: 31228344 DOI: 10.12927/cjnl.2019.25849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This research examined the role and scope of licensed practical nurses (LPNs) in home care (HC) and case management. Case management is relatively new to LPNs in Alberta having been added to their list of competencies in 2015. The extent to which LPNs are performing functions and the circumstances or criteria that shape their reported case management functions and role are not clear. Our research questions were: a) What roles do LPNs play within HC and case management? and b) What roles could LPNs play within HC and case management given their scope of practice to achieve optimal client outcomes and system efficiencies? We used a mixed methods multiple case study design to engage LPNs in case management practice, their managers and HC leaders from rural, urban and suburban HC offices. Approaches for data collection included semi-structured interviews, participant observation, focus groups, document review and survey.
Collapse
Affiliation(s)
- Kimberly Fraser
- Former Associate Professor, Faculty of Nursing University of Alberta, Sessional Professor, Faculty of Health Sciences and Nursing, Athabasca University, Athabasca, AB
| | | | - Beth Wilkey
- Director Infection Prevention and Control, Edmonton Zone, Alberta Health Services, Edmonton, AB
| | - Susan Labonte
- Healthcare Manager - Interior Health British Columbia, Penticton, BC
| | - Sarah Lartey
- Operations Manager, Alberta Health Services, Edmonton Zone, Seasonal Instructor Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Janine Gubersky
- Home Care Nurse, Acting Case Manager, Alberta Health Services, Edmonton Zone, Edmonton, AB
| | - Kimberly Nickoriuk
- Lead, Quality Initiatives and Program Support, Central Zone Seniors Health, Alberta Health Services, Central Zone, Edmonton, AB
| | - Szjermae Joseph
- Lead-Practice Development, Alberta Health Services, Edmonton, AB
| | | | - John Miklavcic
- Assistant Professor, Schmid College of Science and Technology, Food Science School of Pharmacy, Chapman University, Orange, CA
| |
Collapse
|
6
|
Markle‐Reid M, Ploeg J, Fraser KD, Fisher KA, Bartholomew A, Griffith LE, Miklavcic J, Gafni A, Thabane L, Upshur R. Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity. J Am Geriatr Soc 2018; 66:263-273. [PMID: 29178317 PMCID: PMC5836873 DOI: 10.1111/jgs.15173] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. DESIGN Multisite, single-blind, parallel, pragmatic, randomized controlled trial. SETTING Four communities in Ontario, Canada. PARTICIPANTS Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159). INTERVENTION Client-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. MEASUREMENTS Quality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare costs. RESULTS Morbidity burden was high (average of eight comorbidities). Intention-to-treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28-5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02-6.56, P = .01), and CES-D-10 (mean difference = -1.45, 95% CI = -0.13 to -2.76, P = .03). No group differences were seen in PCS score, anxiety, self-efficacy, or total healthcare costs. CONCLUSION Participation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.
Collapse
Affiliation(s)
- Maureen Markle‐Reid
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Jenny Ploeg
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
- Department of Health, Aging and SocietyMcMaster UniversityHamiltonOntarioCanada
| | | | - Kathryn A. Fisher
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
| | - Amy Bartholomew
- Aging Community and Health Research UnitSchool of NursingMcMaster UniversityHamiltonOntarioCanada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - John Miklavcic
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Ross Upshur
- Division of Clinical Public HealthDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
7
|
Markle-Reid M, Ploeg J, Fraser KD, Fisher KA, Akhtar-Danesh N, Bartholomew A, Gafni A, Gruneir A, Hirst SP, Kaasalainen S, Stradiotto CK, Miklavcic J, Rojas-Fernandez C, Sadowski CA, Thabane L, Triscott JAC, Upshur R. The ACHRU-CPP versus usual care for older adults with type-2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial. Trials 2017; 18:55. [PMID: 28166816 PMCID: PMC5294729 DOI: 10.1186/s13063-017-1795-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends). METHODS/DESIGN The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration. DISCUSSION This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014.
Collapse
Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Kimberly D. Fraser
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kathryn Ann Fisher
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Noori Akhtar-Danesh
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street, Hamilton, ON L8S 4K1 Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 6-40 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Sandra P. Hirst
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Caralyn Kelly Stradiotto
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - John Miklavcic
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Carlos Rojas-Fernandez
- Department of Family Medicine, McMaster School of Medicine, Principal, CRF Consulting, 763 Cedar Bend Drive, Waterloo, ON N2V 2R6 Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-229 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, St. Joseph’s Healthcare Hamilton, Room H-325, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jean A. C. Triscott
- Care of the Elderly Division, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| |
Collapse
|
8
|
Miklavcic J, Hart T, Lees G, Schnabl K, Thomson A, Mazurak V, Clandinin M. Inflammatory bowel disease is a disorder of ganglioside metabolism (959.4). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.959.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tasha Hart
- Laboratory Medicine and Pathology University of AlbertaEdmontonABCanada
| | - Gordon Lees
- General Surgery University of AlbertaEdmontonABCanada
| | - Kareena Schnabl
- Laboratory Medicine and Pathology University of AlbertaEdmontonABCanada
| | - Alan Thomson
- Gastroenterology Western University LondonONCanada
| | | | | |
Collapse
|